前交叉韧带重建术后心理准备度和功能结果与重返运动的时间关联：系统综述和Meta分析
简介
这项系统综述与meta分析纳入25项研究、7174例初次ACL重建患者，比较重返运动（RTS，79.3%）与未重返、以及重返伤前水平（RTPre，44.1%）与未重返者之间的心理准备度（ACL-RSI、K-SES、TSK）和功能结局（IKDC、KOOS、肢体对称指数LSI）。主要发现是ACL-RSI的组间差距随术后时间延长而扩大：RTPre与非RTPre组在…
英文摘要
BACKGROUND: Psychological readiness is increasingly recognized as a critical determinant of return to sport (RTS) and return to preinjury level (RTPre) of sport after anterior cruciate ligament (ACL) reconstruction. Functional outcomes are also relevant. However, the clinical significance of psychological readiness and functional outcomes may vary depending on the postoperative time point, and the association of psychological readiness and functional outcomes with RTS may be temporal. This systematic review and meta-analysis aimed to evaluate the temporal association of psychological readiness and functional outcomes with RTS at different postoperative time points (≤6 months, <6-12 months, >12 months) after ACL reconstruction. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO CRD42025630743), 6 databases (MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Web of Science Core Collection, and Scopus) were searched from January 1st, 2008 to April 1st, 2026. Data on psychological measures (ACL-Return to Sport after Injury (ACL-RSI), Knee Self-Efficacy Scale (K-SES), Tampa Scale for Kinesiophobia (TSK)), functional outcomes (International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Limb Symmetry Index (LSI) for knee flexion strength (FLEX-LSI), knee extension strength (EXT-LSI), and single-leg hop distance (SH-LSI)) were extracted from all eligible studies comparing these outcomes between RTS and non-RTS groups, as well as RTPre and non-RTPre groups following primary ACL reconstruction. Effect sizes were pooled as mean differences (continuous variable) or risk ratios (dichotomous variable). Subgroup analyses were stratified by postoperative follow-up time points: ≤6 months, >6-12 months, and >12 months. RESULTS: A total of 25 studies comprising 7174 patients were included. Overall, the RTS rate was 79.3%, whereas the RTPre rate was 44.1%. The RTPre group exhibited significantly higher ACL-RSI scores than the non-RTPre group, and intergroup difference in ACL-RSI widened progressively over time following ACL reconstruction (≤6 months: mean difference (MD) = 16.09, 95% confidence interval (95%CI): 9.13-23.05; >6-12 months: MD = 18.64, 95%CI: 14.64-22.63; >12 months: MD = 27.07, 95%CI: 22.37-31.76). Similar patterns were observed in the comparison of RTS and non-RTS groups. Compared with the non-RTS group, the RTS group showed higher K-SES scores (MD = 1.27, 95%CI: 1.06-1.87; p < 0.0001) and reduced kinesiophobia (TSK/TSK-11, standardized mean difference (SMD) = -1.15, 95%CI: -2.10 to -0.19, p = 0.02). The RTS group also demonstrated superior functional outcomes vs. the non-RTS group, including IKDC (MD = 7.52, 95%CI: 5.85-9.19), KOOS-Sport/Rec (MD = 11.32, 95%CI: 8.84-13.81), KOOS-quality of life (QoL) (MD = 13.97, 95%CI: 10.83-17.10), EXT-LSI (MD = 7.48%, 95%CI: 2.69-12.26), FLEX-LSI (MD = 3.67%, 95%CI: 0.91-6.43), SH-LSI (MD = 2.96%, 95%CI: 1.77-4.16), though IKDC differences remained below established minimal clinically important difference thresholds. CONCLUSION: Psychological readiness assessed via the ACL-RSI is important for RTS evaluation after ACL reconstruction. Our analyses uniquely reveal widening between-group gaps in psychological readiness at later recovery stages, with minimal temporal changes in functional differences. Longitudinal monitoring and serial ACL-RSI evaluation across varied postoperative phases is recommended alongside functional assessments to support RTS decision-making.